Previous Birth Experience
Please fill this form out with information about your previous birth.
Your Partner's Name
Hospital you delivered the last baby at
The care provider who delivered your last baby
What was your due date last time?
When did you actually deliver?
Weight at birth
Did your labor start on its own?
If no, how was labor induced? At how many weeks gestation? What was the reason?
How did your water break
On it's own (SROM)
With assistance (AROM)
Was your labor augmented (helped along in any way?) If yes, please tell me how.
Was Pitocin used?
I don't know
If yes, please tell me about it. When was it used, do you know how much. Did you have an epidural?
Did you use any pain medications? If yes, please list them.
If yes to the above, please tell me about your experience with it. Did it work for you? What did you think of it? Do you plan on using it again?
Please tell me about the pushing stage, how long did you push, what positions did you use?
Did you have...
If you had a cesarean birth, what was the reason you were given as to why?
Any complications in your postpartum healing?
Who supported you during this labor?
What helped you the most during the labor and delivery?
What surprised you the most during the labor and delivery?
Is there anything you would like to do differently this time?
Is there anything you want to do the same?
Did you breastfeed?
For how long?
Did you have any difficulty breastfeeding? Please explain if you did.
Is there anything else about your previous birth you would like to me know about, anything that might be helpful for me to know?